Hypochondriacal Complaints Research Articles

What are we afraid of when we fear for our health? The symptom context of hypochondriacal complaints.

To identify the set of symptoms most frequently co-occurring with hypochondriacal complaints in patients with neurotic or personality disorders. Nonparametric Spearman rank correlations between the variables of symptom checklist "O" describing hypochondriacal symptoms and other symptoms were analyzed. To increase the reliability of the results, the analyses were performed independently in two groups: 3,929 patients before admission to a day hospital in the years 1980-2002 (group A) and 3,190 patients before admission in the years 2004-2015 (group B). For selected groups of patients, lists of correlation coefficients were obtained showing the most important (strongest) and statistically significant associations between five hypochondriacal symptoms and somatization symptoms coming from the muscular system, breathlessness, symptoms coming from the cardiovascular system, anxiety symptoms, and compulsive thoughts without specific content. The multidimensional nature of hypochondriacal complaints and their association with somatization symptoms similar to infection or inflammation were confirmed. Apart from the fears about patient's own health, fears about close relatives are also an important symptom, to which clinical attention should be paid.

Personality Predicts Time to Remission and Clinical Status in Hypochondriasis During a 6-Year Follow-up

We aimed to investigate whether personality characteristics predict time to remission and psychiatric status. The follow-up was at most 6 years and was performed within the scope of a randomized controlled trial that investigated the efficacy of cognitive behavioral therapy, paroxetine, and placebo in hypochondriasis. The Life Chart Interview was administered to investigate for each year if remission had occurred. Personality was assessed at pretest by the Abbreviated Dutch Temperament and Character Inventory. Cox's regression models for recurrent events were compared with logistic regression models. Sixteen (36.4%) of 44 patients achieved remission during the follow-up period. Cox's regression yielded approximately the same results as the logistic regression. Being less harm avoidant and more cooperative were associated with a shorter time to remission and a remitted state after the follow-up period. Personality variables seem to be relevant for describing patients with a more chronic course of hypochondriacal complaints.

Role of anxiety and depressive disorders in the genesis of psychosomatic disorders

Patients and methods. The results of clinical and psychodiagnostic examination using the Minnesota Multiphasic Personality Inventory (MMPI) were analyzed in 210 therapeutic inpatients from 4 groups of psychosomatic diseases (coronary heart disease, hypertensive disease, duodenal ulcer disease, asthma, and bronchitis with an asthmatic component) and 3 groups of diseases in whose genesis the psychosomatic mechanisms (pneumonia, gastritis, renal diseases) played a lesser role. Healthy individuals (n=38) served as a control group. The correlation coefficients between the first scale reflecting the number of somatic complaints and the magnitude of their hypochondriacal fixation and the second one characterizing the degree of anxiety and depressive disorders were calculated within each disease group. Results. In psychosomatic diseases, the correlation coefficients between the first and second MMPI scales proved to be insignificant and substantially lower than those in the healthy individuals. This suggests that in such patients, a larger number of somatic complaints and their enhanced hypochondriacal fixation alleviate anxiety and depressive disorders, which may be regarded as an indication that there is psychosomatic defense that lessens anxiety due to a somatic disease. In somatic diseases that are not referring to as psychosomatic ones, the correlation coefficient between the first and second scales is highly significant and considerably higher than that in the healthy individuals and particularly higher than in the group of psychosomatic diseases. In the patients of these groups, an increase in anxiety and depression aggravates autonomic dysregulation reflecting in the larger number of hypochondriacal complaints. This direct relationship between autonomic functions and the level of anxiety and depression may be a risk factor for developing these disorders.

Trouble factice et dermatillomanie : approche clinique. À propos d’un cas

The number of patients requiring primary and secondary care for factitious disorder unexplained by any known medical condition is high. We report a case illustrating the clinical and psychopathological features of factitious disorder. The treatment difficulties encountered in the association of this disorder with dermatillomania are discussed.The patient was a 22-year old girl with abrasions on the face and forearms with ingested epidermal layer of the skin. She also had multiple somatic complaints, the authenticity of which was difficult to confirm. The diagnosis of comorbid factitious disorder with dermatillomania was retained. In view of reducing self-harm acts, we prescribed a mood stabilizer associated with an anxiolytic for 6 months. The self-harming acts have regressed, while the hypochondriacal complaints remain with a tendency of overstatement.Factitious disorder (FD) is a mental disorder occurring in patients acting intentionally similar to a physically or mentally sick person with no apparent benefits. The reported cases often show FD comorbidity with other psychiatric disorders such as substance abuse, somatoform disorders, dysthymia, borderline personality disorder and sexual disorders. Comorbidity of factitious disorder with neurotic excoriation is exceptional, and rarely described in the literature. Pathological skin picking (PSP) is a disabling disorder characterized by repetitive skin picking, which causes tissue damage. It was estimated to affect 2% of the population. PSP is currently listed as an impulse control disorder not otherwise specified, it is associated with a high rate of psychiatric comorbidity like borderline personality disorder.The comorbidity of factitious disorder and dermatillomania makes diagnosis very difficult. The limit between the two disorders is sometimes unclear.

Living Kidney Donation – Subjective Experiences of Donors before and Two Years after Donation

Little is known about long-term quality of life of kidney donors. We studied subjective experiences of donors before and two years after kidney donation using in-depth interviews of eleven subjects. Interviews were audiotaped, transcribed, and analyzed by qualitative content analysis (grounded theory). Resulting categories of this process were grouped in order to construct ideal types of subjective experiences after kidney donation. Of our donors, 64% were female, mean age was 40.4 years. Donors reported that they had had no medical problems after donation. Most displayed psychological problems, e. g. difficulties adjusting to the new situation, hypochondriacal complaints, and fear of rejection of the recipient’s kidney. Psychological complaints were particularly troublesome in case of complications of the recipient. All donors wished extended counselling after kidney donation. Identifying problems of kidney donors may be easier when doctors are trained in typical experiences. This may also guide the tailoring of individual psychological interventions.

Hypochondriasis Y‐BOCS: a study of the psychometric properties of a clinician‐administered semi‐structured interview to assess hypochondriacal thoughts and behaviours

This study investigated the psychometric properties of the first clinician-administered semi-structured interview for assessing the severity of hypochondriacal symptoms. The Hypochondriasis Yale-Brown Obsessive-Compulsive Scale (H-YBOCS) consisted of three a priori dimensions: hypochondriacal obsessions, compulsions and avoidance. The 16-item interview was conducted with 112 participants with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, hypochondriasis. We analysed factor analytic structure, reliability, construct validity and sensitivity to change. Factor analysis supported a three-factor model similar to the a priori dimensions. Internal consistency ranged from satisfactory to good. Inter-rater reliability was excellent. The construct validity was low to moderate. The H-YBOCS was sensitive for measuring changes in symptom severity. The H-YBOCS is a (factorially) valid and coherent interview with a high level of agreement across different raters. The relatively low discriminant validity could be due to co-morbid anxiety and depressive disorders. Overall, the H-YBOCS seems to be a promising contribution to the assessment of hypochondriasis. *The hypochondriasis Y-BOCS is a feasible clinician rated interview to assess the severity of hypochondriacal complaints.

Kidney Donors' Quality of Life and Subjective Evaluation at 2 Years After Donation

The aim of this study was to investigate the quality of life of renal donors and their subjective evaluation of the donation during long-term follow-up. We interviewed 11 donors 2 to 3 years after kidney donation. The interviews were audiotaped, transcribed, and analyzed by qualitative content analysis based on grounded theory. We grouped the resulting categories to form ideal types of subjective outcome after kidney donation. Of the donors, 64% were female. Mean age was 40.4 years. All donors reported that they had had no medical problems after donation. Most donors experienced some form of psychological problem, such as difficulties adjusting to the new situation at home, hypochondriacal complaints and heightened awareness of bodily sensations, and fear of rejection of the recipient's kidney. Most of the donors felt their relationship to the recipient was good; some had ambivalent feelings toward the kidney recipient. Three main ideal types of donors can be differentiated: the "happy helper," the "ambivalent partner," and the "hypochondriacal complainer." Although donors' subjective outcome after living kidney donation seems to be generally positive, it is worthwhile for the clinician to look for possible psychological problems after donation. Relating a donor to one of the described ideal types may help identify specific difficulties and guide the tailoring of individual psychological interventions. All interviewed donors wished for extended counseling after kidney donation.

Cognitive behavioral therapy versus paroxetine in the treatment of hypochondriasis: An 18-month naturalistic follow-up

Background The present maintenance study investigated whether the reduction in hypochondriacal complaints after initial treatment with CBT or paroxetine sustained during a follow-up period and whether psychiatric severity at pretest predicted the course of hypochondriacal symptoms. Method A naturalistic follow-up period of 18 months after a 16-week RCT consisting of 33 patients initially allocated to a CBT condition and 29 patients to a paroxetine condition. The main outcome measure was the Whiteley Index. Results The initial treatment effect of CBT and paroxetine sustained during the follow-up period. No significant differences between CBT and paroxetine were found. Treatment course could not be predicted by psychiatric comorbidity. Conclusion CBT and paroxetine are both effective treatments for hypochondriasis in the long term.

Cognitive-Behavioural Bibliotherapy for Hypochondriasis: A Pilot Study

The present study aims to determine whether cognitive-behavioural minimal contact bibliotherapy is acceptable to participants suffering from DSM-IV-TR hypochondriasis, and whether this intervention is able to reduce hypochondriacal complaints, as well as comorbid depressive complaints and trait anxiety. Participants were assigned to either an immediate treatment condition, or subsequently to a waiting list condition. Participants were sent a book, Doctor, I Hope it's Nothing Serious?, containing cognitive behavioural theory and exercises. Measures were taken pre, post and at follow-up (after 3 months). Those in the waiting list group received a second pre-assessment, and were then enrolled in the bibliotherapy. Results showed that participants were accepting of the cognitive-behavioural theory. Furthermore, results showed beneficial effects of the intervention: all effect measures decreased significantly over time, with the largest effect at post-assessment. However, a large amount of questionnaires were not returned. It is concluded that bibliotherapy may be an efficient aid in reducing hypochondriacal and comorbid complaints, but due to data attrition and methodological flaws should first be studied further.

Predicting the effect of psychoeducational group treatment for hypochondriasis

Both individual cognitive-behavioural therapy and short-term psychoeducational courses have shown to be effective in reducing hypochondriacal complaints. However, it is unknown which patients benefit from treatment. The aim of the present study is to explore which variables predict treatment outcome in a pooled group of 140 participants of a psychoeducational course. Predictor variables were a) pretreatment hypochondriasis, b) age, c) gender, d) level of education, e) duration of hypochondriacal complaints, f) severity of depressive complaints, g) severity of trait anxiety, and h) treatment expectation. The target scores were residual gain scores of hypochondriacal complaints. Results showed that more severe hypochondriacal complaints at pre- and post-test correlated significantly with more severe hypochondriacal complaints later. Furthermore, higher trait anxiety and older age predicted less treatment gain in hypochondriacal complaints. More research of which variables can predict treatment outcome is needed.

The Effect of a Psychoeducational Course on Hypochondriacal Metacognition

Recently, it has become apparent that a metacognitive perspective may contribute to the understanding and treatment of psychopathology. In this study, the effect of a cognitive-behavioural psychoeducational group treatment for hypochondriasis on metacognitive aspects was examined. Furthermore, it was studied whether earlier found beneficial effects of the course on hypochondriacal complaints, depressive complaints and trait anxiety could be replicated. A total of 35 participants were randomized into either an immediate treatment group (n = 20), or a waiting list control group (n = 15). The participants in the waiting list control group were enrolled in the treatment after a period of 6 weeks. Results showed that the course had an effect on all subscales of the Metacognition-Cognitions about Health Anxiety questionnaire. Furthermore, in line with previous findings, the course proved to be effective in decreasing hypochondriacal complaints, depressive complaints and trait anxiety. It may be concluded that cognitive-behavioural psychoeducational treatment, in which a metacognitive level is implicitly addressed, shows beneficial effect on metacognitive aspects and hypochondriacal complaints.

Psychoeducation for hypochondriasis: A comparison of a cognitive-behavioural approach and a problem-solving approach

In this study, two 6-week psychoeducational courses for hypochondriasis are compared, one based on the cognitive-behavioural approach, and the other on the problem-solving approach. Effects of both courses on hypochondriacal complaints, depression, trait anxiety, and number of problems encountered in daily life, are measured pre-treatment, post-treatment, and at 1- and 6-month follow-up. Participants ( N = 48 , of whom 4 dropped out), suffering from DSM-IV hypochondriasis, were randomized into one of the two course conditions. Results showed beneficial effects of both courses. Few differential treatment effects were found: in both conditions all effect measures decreased significantly over time ( p<0.01). However, between- and inter-individual variability in decrease-patterns was of considerable size, leading to large deviations from the mean pattern. Acceptability and feasibility of both courses were rated highly by their respective participants. It is concluded that both courses can be considered equally beneficial and effective over time, with the effects evident immediately after treatment and maintained over the follow-up period.

Depressive disorders preceding temporal lobe epilepsy

In this study, we investigated three female patients given a diagnosis of temporal lobe epilepsy preceded by depression. It is notable that all the patients complained of abnormal sensations, either in the throat or oral. The depression in the three patients showed no improvement with antidepressants, but carbamazepine was effective for both epileptic seizures and depression. EEG should be performed on patients who develop antidepressant treatment-refractory depression accompanied by hypochondriacal complaints.

Frontal variant of frontotemporal dementia: a cross-sectional and longitudinal study of neuropsychiatric features.

The term frontotemporal dementia (FTD) covers both the temporal and frontal presentations of this condition. The frontal variant (fv) presents with insidious changes in personality and behaviour, with neuropsychological evidence of disproportionate frontal dysfunction. Although psychiatric features are well recognized, there is little systematic data examining the mental state using assessment instruments and no reported studies of the longitudinal progress and assessment. Fifteen patients with a diagnosis of FTD(fv) were assessed using the Comprehensive Psychiatric Rating Scale (CPRS). A subgroup of five patients were reassessed annually using the same instrument, generating data over a 3-year period. At initial assessment a third of 15 patients had no psychiatric symptoms to report. Three patients reported symptoms of sadness, but only one patient met criteria for DSM-IV major depressive episode. One patient experienced symptoms of elation, but did not meet criteria for manic episode, while two patients had hypochondriacal complaints but did not meet DSM-IV criteria for hypochondriasis. One of these patients also experienced the compulsion to count but did not meet criteria for obsessive compulsive disorder. The objective mental state was, on the whole, not congruent with the reported symptoms. Five patients assessed over a 3-year period showed no progression of their subjectively reported symptoms. Psychiatric symptoms although often present were characterized by their shallowness, lack of elaboration and non-development over time.

Hypochondriasis: the role of fear-confirming reasoning

We investigated whether hypochondriacal patients are prone to selectively search for danger-confirming information when asked to judge the validity of conditional rules in the context of general and health threats. Therefore, hypochodtriacal patients ( n=27) and a healthy control group ( n=27) were presented with modified Wason Selection Tasks (WSTs) pertaining to general and health threats. The WSTs contained safety rules (If P then safe) and danger rules (If P then danger). Subjects adopted a verificationistic strategy in case of danger rules and tended to look for falsifications in case of safety rules. This danger-confirming reasoning pattern was similar for both types of contexts and not particularly pronounced in hypochondriacal persons. These findings argue against the idea that such a reasoning pattern directly causes hypochondriasis. Yet, in the presence of anxiogenic (hypochondriasis related) convictions such danger-confirming reasoning pattern logically serves to maintain or even enhance hypochondriacal complaints.

V-6-79 - Follow-up studies of transplantation of fetal substantia nigra for Parkinson's disease

Stereotaxic pallidotomy for Parkinson's disease (PD) is an old concept, which was gradually and mostly replaced by thalamotomy. Recently, posteroventral pallidotomy (PVP), originally proposed by Leksell et al., was reintroduced; this paper examines PVP in terms of its historical background, technical aspect and location of the surgical lesion, as well as clinical effects on motor and psychological symptoms. Posteroventral pallidotomy has been shown to be satisfactory in relieving rigidity and secondary akinesia, but not powerful enough in alleviating severe tremor. These are similar observations to those made in classical pallidotomy. For this reason, all PVP-treated cases reported in this paper have an additional small thalamic lesion for control of tremor. Also, it must be recognized that most of the surgically treated patients are continuing to take medication at the same or slightly lowered dose compared with preoperatively. Dopa-induced dyskinesia is alleviated well by PVP, similar to thalamotomy. The most important question is whether PVP has more effect on truncal symptoms, such as postural imbalance, and on gait than thalamotomy, a question that is still not satisfactorily answered in both clinical and basic analysis. Parkinson's disease-induced changes in emotional status, such as depression or hypochondriacal complaints, are favorably influenced by PVP, but not by thalamotomy. The role of stereotaxic surgery in the era of pharmacological treatment is discussed, as is the possible importance of the role of the limbic-motor circuit in research on PD.

V-6-78 - Chronic brain stimulation therapy for post-stroke involuntary movement disorders

Stereotaxic pallidotomy for Parkinson's disease (PD) is an old concept, which was gradually and mostly replaced by thalamotomy. Recently, posteroventral pallidotomy (PVP), originally proposed by Leksell et al., was reintroduced; this paper examines PVP in terms of its historical background, technical aspect and location of the surgical lesion, as well as clinical effects on motor and psychological symptoms. Posteroventral pallidotomy has been shown to be satisfactory in relieving rigidity and secondary akinesia, but not powerful enough in alleviating severe tremor. These are similar observations to those made in classical pallidotomy. For this reason, all PVP-treated cases reported in this paper have an additional small thalamic lesion for control of tremor. Also, it must be recognized that most of the surgically treated patients are continuing to take medication at the same or slightly lowered dose compared with preoperatively. Dopa-induced dyskinesia is alleviated well by PVP, similar to thalamotomy. The most important question is whether PVP has more effect on truncal symptoms, such as postural imbalance, and on gait than thalamotomy, a question that is still not satisfactorily answered in both clinical and basic analysis. Parkinson's disease-induced changes in emotional status, such as depression or hypochondriacal complaints, are favorably influenced by PVP, but not by thalamotomy. The role of stereotaxic surgery in the era of pharmacological treatment is discussed, as is the possible importance of the role of the limbic-motor circuit in research on PD.

Posteroventral pallidotomy: its effect on motor symptoms and scores of MMPI test in patients with Parkinson's disease

Stereotaxic pallidotomy for Parkinson's disease (PD) is an old concept, which was gradually and mostly replaced by thalamotomy. Recently, posteroventral pallidotomy (PVP), originally proposed by Leksell et al., was reintroduced; this paper examines PVP in terms of its historical background, technical aspect and location of the surgical lesion, as well as clinical effects on motor and psychological symptoms. Posteroventral pallidotomy has been shown to be satisfactory in relieving rigidity and secondary akinesia, but not powerful enough in alleviating severe tremor. These are similar observations to those made in classical pallidotomy. For this reason, all PVP-treated cases reported in this paper have an additional small thalamic lesion for control of tremor. Also, it must be recognized that most of the surgically treated patients are continuing to take medication at the same or slightly lowered dose compared with preoperatively. Dopa-induced dyskinesia is alleviated well by PVP, similar to thalamotomy. The most important question is whether PVP has more effect on truncal symptoms, such as postural imbalance, and on gait than thalamotomy, a question that is still not satisfactorily answered in both clinical and basic analysis. Parkinson's disease-induced changes in emotional status, such as depression or hypochondriacal complaints, are favorably influenced by PVP, but not by thalamotomy. The role of stereotaxic surgery in the era of pharmacological treatment is discussed, as is the possible importance of the role of the limbic-motor circuit in research on PD.

Transient Hypochondriasis: A New Somatoform Diagnosis?

<h3>To the Editor.—</h3> Barsky and colleagues¹conducted an important investigation in medical patients. They describe a group of patients with transient hypochondriacal complaints that decreased significantly over 3 weeks. Patients with transient hypochondriacal complaints had more medical morbidity, more Axis I disorder, more personality disorder, and higher levels of amplification of somatosensory perceptions. In the discussion, the authors propose investigating transient hypochondriasis as a distinct and separate diagnosis. I propose additionally investigating this phenomenon as a part of already defined<i>DSM-III-R</i>diagnoses.²First, the authors do not comment on how transient hypochondriasis differs from<i>DSM-III-R</i>adjustment disorder with physical complaints. Supporting evidence that these disorders may be the same includes the transient nature of symptoms—adjustment disorders by definition are limited to 6 months or less. Transient hypochondriasis patients also were more medically ill, suggesting that medical illness may be the identifiable psychosocial stressor necessary for diagnosis of an

Neurotic and psychosomatic disorders interdependence in terms of the search activity concept

There are no correlations between MMPI Hysteria (Hs) and Depression (D) scales in psychosomatic patients in contrast to other patients with somatic disturbances, neurotic disturbances, and in healthy subjects. The roles of depression and hypochondria in the dynamics of psychosomatic disturbances are discussed according to the search activity concept. It is suggested that hypochondriacal complaints are prognostically favorable in comparison with anxiety-depression complaints.